Acute Care Across the Lifespan B

This essay discusses the issue that Mrs. Kennedy is facing, analyzes the changes in her clinical representation, evaluates the priorities of care, and discusses the psychosocial issues related to her current disease stage.

Running Head: Acute Care Across the Lifespan B
ACUTE CARE ACROSS THE LIFESPAN B

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Acute Care Across the Lifespan B
Table of Contents
1. Introduction............................................................................................................................3
2. Analyzing the changes in clinical representation of Mrs. Kennedy.......................................3
3. Discussing and critically evaluating the priorities of care.....................................................5
4. Discussing the psychosocial issues related to current disease stage of Mrs. Kennedy..........7
5. Conclusion..............................................................................................................................7
Reference list..............................................................................................................................9

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1. Introduction
The purpose of this essay is to discuss the issue that Mrs. Kennedy is facing by using
clinical reasoning cycle and critically analyze the priorities of care. Mrs. Kennedy has
previous history of ischemic heart disease, hypertension, and PVD. Considering the
situation of the patient, it can be said that her condition is deteriorating as her vital signs
like pulse rate, BP, respiratory rate is showing abnormality. Pathophysiological process has
been discussed in this essay, which means mechanism behind the development of a condition.
Setting nursing priorities is essential for providing treatment in a systematic way, which
eliminates any error in practice. Nursing problems are solved by establishing a preferential
order. In this case, the recent health deterioration of Mrs. Kennedy has increased the need for
priority setting to avoid any emergency situation. Moreover, she has undergone CABG and
PTCA that states she has a poor heart condition and need attention immediately.
2. Analyzing the changes in clinical representation of Mrs. Kennedy
Collection of information is an important part of understanding the issue. Before the
pressure sensation felt by the patient on her chest, vital signs have been measured. The
temperature of the body was 37.3°C, pulse rate was 74 bpm, strong volume and regular.
Respiratory rate of this patent was 14/min, regular with normal depth. BP was 165/90, which
is normal for her and the SpO2 was 98% on room air. The changes in vital sign take place
after 30 min, the patient was a little diaphoretic and she has felt a mild pressure sensation in
her chest. At that stage, the temperature was near about the same, but the pulse rate has been
increased to 116bpm, regular. However, the pulse rate was not strong. The respiratory rate
has been slower to 26/min. BP dropped to 105/70 mm-Hq. SpO2 level fallen to 92% on room
air. She has a history of Ischemic Heart Disease (IHD) beginning peripheral vascular disease

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(PVD) and hypertension. Six years ago, she has experienced CABG with saphenous vein
graft to the diagonal branch and left anterior descending (LAD). She underwent PTCA with
stenting to RCA and PDA, 2 years ago.
Processing information is the next step for understanding the issue. Her heart rate
has been increased with the RR. As per the Starling Law, the volume of stroke and the end-
diastolic volume is interrelated (Cvphysiology.com, 2019). Before contraction, when all
factors are constant, an increase of blood volume in the ventricle causes an increase in stroke
volume. In the case of this patient, this mechanism has taken place and as a result, her heart
rate and pulse rate has been increased. Diaphoretic with cool peripherals have been noted.
Identification of the issue can be done after getting the processed information. Increased
heart rate with this symptom refers to a heart attack of this patient. Mild chest pain and a
slight ache in the upper left arm are confirming her heart attack. According to Weinstock et
al. (2015), after 8 to 10 years of CABG, the chances of death have increased by near about
60-80%. Mrs. Kennedy has undergone CABG before 6 long years and at present, her risk of
mortality has increased. In this case, her BP has been dropped. Maybe this situation has
occurred due to pumping of less amount of blood by the heart. As mentioned by Foy, Liu,
Davidson, Sciamanna & Leslie (2015), during a heart attack, BP can be lowered in response
to the pain occur. However, in this case, the pain was mild as the patient has rated her chest
pain 4/10. It means that BP has not fallen because of the pain. As mentioned by Sandhu,
Heidenreich, Bhattacharya & Bundorf (2017), heart attack normally takes place when the
oxygenated blood flow to the heart reduces. It means that the SpO2 level of Mrs. Kennedy
has dropped due to the occurrence of a heart attack. This patient has undergone PTCA two
years ago. It means that she may have experienced a heart attack previously. History of CAD
of this patient has caused this heart attack.

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3. Discussing and critically evaluating the priorities of care
Priorities of care can be analyzed by setting goals and analyzing the previous history
of disease. Mrs. Kennedy has undergone surgeries like CABG and PTCA. Moreover, her
chest pain has increased recently. Current vital signs show a decrease in condition of this
patient.
Establishing goals: As she is sweating and an increase in respiratory and pulse rate is
evident then it can be a sign of heart attack. Hence, primary care priority is to eliminate these
issues and provide comfort to the patient (Dewey et al. 2016). Moreover, she has also
reported about her chest pain and recently she is also feeling pressure in her chest. This is
another essential problem that needs to be mitigated on the basis of priority. She has
undergone different surgeries like PTCA and CABG. She has a history of coronary artery
disease. Hence, it is essential to priorities the chest pain and takes adequate action to
minimize chest pain that she is facing. This can also help to improve her vital signs.
Taking actions
As a nurse, it is also the main duty to conduct vital tests for measuring the situation
properly. Testing like echocardiogram can be performed to measure the condition of patient's
heart. As stated by Amakali (2015), an echocardiogram uses sound waves to produce a video
image of the heart in motion. Other tests like CT scan can also be performed in this case. This
test is performed to monitor heart arteries for finding blockages. Mrs. Kennedy has
undergone surgeries in her right coronary artery two years ago and had vein grafting on left
anterior artery. Hence, it is essential for a medical professional to perform a CT scan of this
type of patient. In this case, CT coronary angiogram can be performed with dye for checking
heart arteries of this patient. In ABCs of nursing, assessment can be done through the help of
these lab tests. However, these tests need to be done as prescribed by a general physician
(Rnnetwork.com, 2013). Different tests like a CT scan, ACG and blood tests of different

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enzymes and proteins that are found in heart muscles can be done. For controlling the chest
pain, checking basic vitals is also necessary. Different vitals like blood pressure, saturation,
pulse patterns, rate of respiration and body temperature needs to be monitored carefully and
regularly. The pulse rate in this type of patients seems to be high, which acts as a
compensatory to low cardiac output. The volume is shallow due to low pressure of cardiac
output (Mayoclinic.org, 2019). The blood pressure also shows abnormal behavior. Both
systolic and diastolic pressure seems to be high or low. In this case, given, the blood pressure
has elevated in the first instance while it gets decreased from normal level afterward. This
disproportion signifies circulatory congestion. Saturation level can also be lower due to low
cardiac output. However, in this case, it is at normal level. Respiration, in this case, is faster
than normal level due to hypoxia. These vital sign must be measured periodically that can
help in monitoring the patient closely.
As immediate care priority, she can be provided with some drugs that can help to
control her vital signs and provide relief from chest pain. During administering drugs, it is
essential to observe right dose and provide right drug in a proper way (Kisely, Campbell,
Yelland & Paydar, 2015). This can be done by monitoring the vital signs and consulting with
physicians. Drugs need to be applied to Mrs. Kennedy after prescribing by doctors. Artery
relaxers like Nitroglycerin tablets can be provided that helps in relaxing heart arteries
(Lambe, Currey & Considine, 2017). Relaxing heart arteries helps to flow the blood more
easily through the narrow space. Moreover, Seifert (2019) contradicted that aspirin can also
be applied to a patient that helps to provide relief from chest pain. Thrombolytic drug can
also help to stop blood clotting in the arteries and normalize blood flow. Hence, this can also
help in reducing chest pain in the patient. Thrombolytic drugs are clot-busting drugs that
dissolve clot and this eases blood to reach heart muscles (Medlineplus.gov, 2018).

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Hence, these actions can be performed by a nurse to provide relief to Mrs. Kennedy
from chest pain. This is a primary priority in this nursing care that can help to normalize the
vital signs and prevent the risk of a heart attack.
4. Discussing the psychosocial issues related to current disease stage of Mrs. Kennedy
In this current stage of an issue, Mrs. Kennedy needs support and care from her
family members. Evaluation of outcome must be done to understand the exact process of
giving nursing care to this patient (Hess et al. 2016). Previously, required medical support
has been mentioned for this patient. The mentioned medications and clinical care may help
this patient to recover fast. However, psychosocial issues may delay the process of recovery
of this patient. In this case, Mrs. Kennedy is facing social isolation. This 56 years old woman
lives alone in a rented home. She has a son, who lived in Melbourne. Her son rarely visits her
house and this loneliness is one of the main psychosocial issues that is being faced by this
patient. She is self-dependent women and does not want to take other's help. This is another
psychosocial issue of her life. Probably, she wants the company of her son and does not want
to take help from maids and caregivers. According to Bourgeois, Orenstein, Ballakur, Mandl
& Ioannidis (2017), older people face many physical issues during their old age. Due to this
reason, they must live with their family members at this stage of life. However, the life
situation of Mrs. Kennedy is difficult as she is suffering from heart disease and chest pain. A
medical emergency may take place at anytime and she could fail to manage that situation
alone. It is important for her son to think about this matter and stay with his mother.
5. Conclusion
From the entire discussion, it can be concluded that Mrs. Kennedy is facing the
changes in her vital signs due to heart attack and her previous history of health are playing an

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important role in this case. Reflecting on process has helped to understand that effective
nursing care and useful drugs may help this patient to recover fast. On the other hand,
psychological issues including leaving alone and denying taking help from others may
increase the risk of this patient. From this process, necessary nursing practice to handle this
kind of patient has been learned. Being a nurse, monitoring of vital signs is important to
practice in case of emergency of patients with CABG and PTCA background. Drugs and
other medical care must be given by nurses after consulting with concerned doctor.

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Reference list
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Bourgeois, F. T., Orenstein, L., Ballakur, S., Mandl, K. D., & Ioannidis, J. P. (2017).
Exclusion of elderly people from randomized clinical trials of drugs for ischemic
heart disease. Journal of the American Geriatrics Society, 65(11), 2354-2361.
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Cvphysiology.com. (2019). Frank-Starling Mechanism. Retrieved on 29th August 2019, from:
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Leblanc, A. (2016). Shared decision making in patients with low risk chest pain:

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